Surgical retractor and related methods

ABSTRACT

A surgical retractor includes a base defining an open area therein to correspond with a surgical incision in a body. The base has an inner wall facing the open area and an outer wall facing away from the open area. A plurality of channels extend through the base between the inner and outer walls, and at least one of the channels is at an angle offset from normal to the inner wall where the at least one channel intersects the inner wall. A respective retractor arm is carried within each of the channels for retracting the body to open the surgical incision. In a surgical method, such as a thyroidectomy, a base is positioned so that the open area corresponds with a surgical incision in a body. Respective retractor arms carried within each of the channels are moved to retract the body to open the surgical incision.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application Ser.No. 60/940,061, filed on May 24, 2007, the contents of which are hereinincorporated by reference in their entirety.

FIELD OF THE INVENTION

The present invention relates to surgical retractors and relatedmethods.

BACKGROUND OF THE INVENTION

To properly perform invasive surgical procedures, it is often necessaryto retract skin, muscle and other body tissue surrounding the surgicalincision to allow the surgeon a clear view of the area to be operated onand room to use the required surgical tools.

Hand retractors are commonly employed for this purpose, typicallyhandled by an assistant. An end of the hand retractor is inserted in theincision and moved to retract the desired tissue. However, handretractors are often unwieldy, require frequent attention and tie up oneor more hands of the assistant. Even if further assistants are availableto the surgeon, the presence of too many personnel tends to crowd thesurgical area.

Surgical retractors, usually including a basic frame with one or moreretractors clamped thereto, are sometimes employed to alleviate the needfor hand retractors and the corresponding dedicated personnel. However,such surgical retractors are often bulky, impeding access to thesurgical incision, and frequently offer limited options concerning themanner in which retraction of the body around the incision isaccomplished.

One example of an attempt to improve the utility of a surgical retractorcan be seen in U.S. Pat. No. 1,400,616, in which an abdominal retractorhas a frame contoured to fit a patient's body. A plurality of holesextend through the frame. Threaded stems with retraction fingers on anend thereof can be inserted through any of the holes. The holes are alloriented normal to the corresponding sections of the frame, resulting inlimited options for the direction in which the body can be retractedaround an incision. Additionally, the threaded stems requiretime-consuming screwing and unscrewing of a nut to secure the stems in adesired position.

Another example can be seen in U.S. Pat. No. 3,522,799, in which asurgical retractor has a plurality of support arms with retractor bladeson ends thereof that can extend from respective portions of a frame at avariable angle. While the 1799 patent offers increased options for bodyretraction around an incision, substantially increased bulk andcomplexity of equipment is required in exchange.

A further example can be seen in U.S. Patent Application Publication No.2004/0242969 in which a surgical retractor has retractor blades that areadjustable using a ratchet and pawl system. While the ratchet and pawlsystem allows for quicker operation relative to the threaded stems ofthe '616 patent, the ratchet and pawl system also adds substantially tothe overall bulk of the surgical retractor.

Additionally, while some surgical retractors offer basic contouring ofthe frame for areas such as the back or abdomen, surgical retractorsshaped or contoured for more complex geometries are lacking.

SUMMARY OF THE INVENTION

In view of the foregoing background, it is therefore an object of thepresent invention to provide a surgical retractor and related methodsthat provide enhanced retraction features.

This and other objects, features, and advantages are provided by asurgical retractor including a base defining an open area therein tocorrespond with a surgical incision in a body, the base having an innerwall facing the open area and an outer wall facing away from the openarea. A plurality of channels extend through the base between the innerand outer walls, and at least one of the channels is at an angle offsetfrom normal to the inner wall where the at least one channel intersectsthe inner wall. A respective retractor arm is carried within each of thechannels for retracting the body to open the surgical incision.

A method aspect may include positioning a base, such as the base brieflydescribed above, so that the open area corresponds with a surgicalincision in a body. Respective retractor arms carried within each of thechannels are moved to retract the body to open the surgical incision.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of a surgical retractor including a base and aplurality of retractor arms, according to an embodiment of the presentinvention.

FIG. 2 is a cross-sectional view of the surgical retractor taken alongline 2-2 of FIG. 1.

FIG. 3 is an enlarged view of area 3 of FIG. 2.

FIG. 4 is a top view of a retractor arm of FIG. 1.

FIG. 5 is a side view of the retractor arm of FIG. 4.

FIG. 6 is a top view of another retractor arm of FIG. 1.

FIG. 7 is a side view of the retractor arm of FIG. 6.

FIG. 8 is a bottom view of the surgical retractor of FIG. 1.

FIG. 9 is a flow diagram of a surgical procedure employing a surgicalretractor according to an embodiment of the present invention.

FIG. 10 is a flow diagram detailing a portion of the procedure of FIG. 9in the context of a thyroidectomy or related procedure.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention will now be described more fully hereinafter withreference to the accompanying drawings, in which preferred embodimentsof the invention are shown. This invention may, however, be embodied inmany different forms and should not be construed as limited to theembodiments set forth herein. Rather, these embodiments are provided sothat this disclosure will be thorough and complete, and will fullyconvey the scope of the invention to those skilled in the art. Likenumbers refer to like elements throughout.

Referring initially to FIG. 1, a surgical retractor 10 illustrativelyincludes a base 12 defining an open area 14 for disposing over asurgical incision in a body. In the embodiment shown, the base 12completely surrounds the open area 14. However, other embodiments, inwhich the base 12 only partially surrounds the open area 14, are alsopossible. The retractor 10 further includes a plurality of retractorarms 20-30 slidably arranged in a plurality of channels 32 formed in thebase 12.

Referring to FIG. 2, the base 12 is formed with an inner wall 40 and anouter wall 42. The inner wall 40 substantially surrounds and faces theopen area 14. The channels 32 extend through the base 12 between theinner wall 40 and the outer wall 42. Advantageously, the base 12 can beformed by plastic injection molding as a single piece, although othermaterials and forming techniques can also be employed. Moreover, thebase 12 need not be a unitary piece in all embodiments.

Referring to FIG. 3, the base 12 includes a plurality of tabs 46overlying the channels 32 (only one exemplary channel 32 and tab 46 areshown in FIG. 3 for clarity of illustration). The tabs 46 have posts 48for engaging the retractor arms 20-30. The posts 48 include roundedsurfaces 50 facing towards the open area 14 and flat surfaces 52 facingaway from the open area 14.

The tabs 46 are flexible in the direction of arrow 54 to selectivelydisengage the posts 48 from the retractor arms 20-30. The resiliency ofthe tabs 46 is effective to bias the tabs 46 opposite the direction ofarrow 54 when flexed. To facilitate manual flexion of the tabs 46, thetabs have distal ends 56 proximate to the posts 48, the distal ends 56being angled away from the retractor arms 20-30. Other configurationsand numbers of tabs and posts, as well as other locking mechanismdesigns, may also be used.

Referring to FIGS. 4-7, the retractor arms 20-30 include elongatesections 60 that are slidably disposed within respective channels 32.Body engagement extensions 62 depend from the elongate sections 60 ofthe retractor arms 22, 30, and body engagement extensions 64 depend fromthe elongate sections 60 of the retractor arms 20, 24-28. As will beappreciated from a comparison of FIGS. 4 and 5 with FIGS. 6 and 7, inthe illustrated example the body engagement extensions 62 are longerthan the body engagement extensions 64. However, the various bodyengagement sections may be the same length in some embodiments, ordifferent sections may be different lengths or shapes. Body engagementextensions 62, 64 extend from the elongate sections 60 at an angle 66,for example an acute angle of forty-five degrees.

A plurality of holes 70 are defined within the elongate sections 60. Theplurality of holes 70 are selectively engageable by the posts 48 of thetabs 46 (see FIG. 3), with engagement between the flat surfaces 52 andthe holes 70 inhibiting further sliding of the retractor arms 20-30 intothe open area 14 without flexion of the tabs 46 in the direction ofarrow 54.

Safety stops 72 are also optionally formed on the elongate sections 60of the retractor arms 20-30. The safety stops 72 extend outwardly fromthe elongate sections and engage recessed portions 74 of the inner wall40 proximate to the channels 32 (see FIG. 3). The safety stops 72inhibit the retractor arms 20-30 from being withdrawn to the point wherethe body engagement extensions 62, 64 engage the base 12. The safetystops 72 reduce the risk of pinching portions of the body in the area ofthe incision and the resultant physical trauma.

It will be appreciated that the surgical retractor 10 according theillustrated embodiment presents an extremely low profile (see also FIG.8) having no bulky protrusions or added equipment to potentiallyrestrict access to the surgical incision by a surgeon, although aspectsof the present invention can be used in connection with surgicalretractors having higher profiles and the like.

The combination of tabs 46 with posts 48 and holes 70 in the elongatesections are a particularly advantageous retractor arm locking mechanismin connection with a low profile surgical retractor, allowing arelatively high resistance to retractor arm disengagement whenretracting the body for a relatively low overall height of the tabs 46and posts 48. It will be understood that this locking mechanism can alsobe advantageously employed in connection with surgical retractors havinghigher profiles, and that other aspects of the present invention can beused in connection with surgical retractors having other lockingmechanisms. Other suitable locking mechanisms may also be used.

The exemplary design of safety stops 72 illustrated herein is alsoadvantageous in connection with low-profile surgical retractors,effectively operating to halt body retraction without substantiallyadding to the bulk or profile of the surgical retractor 10. Other safetystop 72 designs can also be employed in connection with the presentinvention, or safety stops 72 can be omitted if desired.

Surgical retractors including aspects and advantages of the presentinvention can be employed in connection with incisions on multiplesections of a human or animal body, and the present invention is notnecessarily limited to any particular configuration or shape of the baseor open area, or any particular configuration, shape or number ofretractor arms.

However, the exemplary embodiment of a surgical retractor 10 shown anddisclosed herein is particularly suitable for use in connection with athyroidectomy and related procedures, in which the base 12 is positionedover a neck and clavicle section of the body.

Referring to FIG. 1, the base 12 is formed with a single line ofsymmetry (coincident with the sectional line 2-2). The base 12 has aplurality of segments 80-94, such that the inner wall 40 and outer wall42 approximately define polygons. With reference to the orientation ofFIG. 1, the segments 82, 94 are disposed above the segment 80, such thatsymmetrical lobes 100 are formed.

The segments 80, 82, 86-90, 94 have channels 32 extending therethroughfor respective retractor arms 20-30. Segments 84, 92 do not havechannels extending therethrough. The channels 32 extending through thesegments 82, 86, 90, 94 are arranged at angles offset from normalrelative to the segments 82, 86, 90, 94, and relative to where thesechannels 32 intersect the inner and outer walls 40, 42.

In the context of a thyroidectomy or related procedures, for segments82, 94, an angle in an exemplary range of about ten to thirty degrees,and preferably about twenty degrees, from normal prevents interferencebetween the retractor arms 22, 30 and the jaw. For segments 86, 90, anangle in an exemplary range of about twenty to forty degrees, andpreferably about thirty degrees, from normal prevents interferencebetween the retractor arms 24, 28 and the clavicles. Also, the lobes 100allow segment 80 to be located below, relative to the orientation ofFIG. 1, than segments 82 and 94. This exemplary arrangement maximizesthe size of open area 14 while preventing interference between segment80 and the underside of the chin, in a thyroidectomy or relatedprocedure.

Referring additionally to FIGS. 1 and 8, the base 12 is contoured suchthat the segments 82-86 and segments 80-94 form respective wings 102sloping away from segments 80 and 88. The base 12 between the wings 102presents an approximately concave profile, facilitating placement of thesurgical retractor 10 over corresponding convex section of the body,such as the neck and upper chest in the example of a thyroidectomyprocedure.

Referring to FIG. 9, a surgical method, employing a surgical retractoraccording to an embodiment of the present invention, starts at block200. For illustrative purposes, references will be made to the surgicalretractor 10 described above. At block 202, the base 12 is positionedover the body so that the open area 14 corresponds to the surgicalincision. Typically, the surgical incision is made before the base 12 ispositioned over the body. However, the present invention is notnecessarily limited to such a sequence and the base 12 can also bepositioned over the body before the surgical incision is made. In suchan instance, the open area 14 corresponds to the surgical incision inthat the open area 14 corresponds to where the surgical incision will bemade.

At block 204, the retractor arms 20-30 are moved to retract the bodysurrounding the surgical incision, opening the surgical incision. Movingthe retractor arms 20-30 can be accomplished by manually gripping theelongate sections 60 to move the body engagement extensions 62, 64toward the inner wall 40 of the base. As the retractor arms 20-30 aremoved, rounded surfaces 50 of posts 48 engage edges of holes 70resulting in flexion of tabs 46 in the direction of arrow 54. As aresult, manual manipulation of tabs 46 is not normally employed whenretracting the body. Over-retraction of the body by retractor arms 20-30is prevented by the safety stops 72.

When retractor arms 20-30 are released, if posts 48 are in holes 70,engagement between flat surfaces 52 and edges of holes 70 will inhibitmovement of body engagement extensions 62, 64 back into the open area14, maintaining the body in the retracted position around the surgicalincision. If posts 48 are not in holes 70 when retractor arms 20-30 arereleased and forces exerted by the retracted body act to move the bodyengagement extensions 62, 64 back into the open area 14, the resiliencyof the tabs 46 will seat the posts 48 in adjacent holes 70. Uncontrolledrelease of retraction of the body is thereby limited to the distancebetween adjacent holes 70.

Once the surgical incision is opened, surgery is performed as necessaryor desired. Once the surgery is complete or access through the openincision is no longer required, at block 206, the retractor arms 20-30are moved to disengage the body and the base 12 is removed from thebody. To move the retractor arms 20-30 to disengage the body, the distalends 56 of the tabs 46 are manually engaged to flex the tabs 46 in thedirection of arrow 54. Sufficient flexion of the tabs 46 disengagesposts 48 from holes 70, allowing the body engagement extensions 62, 64to be moved back in to the open area 14. At block 208, the method ends.Actions to close the incision and treat the body are performed asappropriate in coordination with the described procedure, as will beappreciated by those skilled in the art.

As described above, the exemplary embodiment of the surgical retractordescribed herein is particularly suitable for use in connection withthyroidectomy and related procedures. In connection with suchprocedures, the block 202 positioning of the base 12 includespositioning the base 12 over the neck and clavicle section of the body12.

The open area 14 should surround the surgical incision in the neck, withthe segment 88 resting near the junction of the clavicles. The concavecontour between the wings 102 allows the base 12 to fit about theapproximately convex profile of the neck. The positioning of segment 80below lobes 100 allows additional clearance between the retractor arm 20and the chin.

Referring to FIG. 10, an advantageous method of moving the retractorarms 20-30 to retract the body surrounding the surgical incision (as atblock 204 of FIG. 9) in connection with a thyroidectomy or relatedprocedure is described in greater detail. At block 210, the retractorarms 20, 26 are moved to retract the sub-platysma muscle flap createdafter the initial surgical incision is made.

At block 212, the Sternocleidomastoid, Sternothyroid and Sternohyoidmuscles are divided midline and freed of underlying tissue. At block214, the retractor arms 22, 30 are moved to lift and displace theSternohyoid muscles and underlying tissue. As a result, a surgeon isprovided with improved vision of the Superior Thyroid artery andSuperior Thyroid vein for ligation, as well as the Superior Laryngealnerve and Superior Parathyroid glands for preservation. Because of theangle at which the channels 32 route the retractor arms 22, 30 throughthe respective segments 82, 94, movement of the retractor arms 22, 30does not interfere with the chin or jaw of the body.

At block 216, the retractor arms 24, 28 are moved to retract theinferior aspect of the Sternothyroid muscles and underlying tissue. As aresult, ligation of the Inferior Thyroid artery and Inferior Thyroidvein, and preservation of the Recurrent Laryngeal nerve and InferiorParathyroid glands, are facilitated. Because of the angle at which thechannels 32 route the retractor arms 24, 28 through the respectivesegments 86, 90, movement of the retractor arms 24, 28 does notinterfere with the clavicles of the body.

Many modifications and other embodiments of the invention will come tothe mind of one skilled in the art having the benefit of the teachingspresented in the foregoing descriptions and the associated drawings.Therefore, it is understood that the invention is not to be limited tothe specific embodiments disclosed, and that modifications andembodiments are intended to be included within the scope of the appendedclaims.

1. A surgical retractor comprising: a base defining an open area thereinto correspond with a surgical incision in a body, said base having aninner wall facing the open area and an outer wall facing away from theopen area; said base having a plurality of channels therein extendingbetween the inner and outer walls, and at least one of the channelsbeing at an angle offset from normal to the inner wall where the atleast one channel intersects the inner wall; a respective retractor armcarried within each of the channels for retracting the body to open thesurgical incision.
 2. The surgical retractor of claim 1 wherein the atleast one channel comprises a plurality thereof.
 3. The surgicalretractor of claim 1 wherein at least one other of the plurality ofchannels is normal to the inner sidewall where the at least one otherchannel intersects the inner sidewall.
 4. The surgical retractor ofclaim 1 wherein each of said retractor arms comprises: an elongatesection slidably carried within a respective channel; and a bodyengagement extension carried by said elongate section within the openarea for engaging the surgical incision.
 5. The surgical retractor ofclaim 4 wherein each of said retractor arms further comprises a safetystop carried by said elongate section for engaging the inner wall ofsaid base to prevent retraction of the incision beyond a safety limit.6. The surgical retractor of claim 1 wherein the open area has a singleaxis of symmetry.
 7. The surgical retractor of claim 1 wherein the openarea has at least one lobe portion.
 8. The surgical retractor of claim 1wherein at least one of the inner walls and outer walls defines apolygon.
 9. The surgical retractor of claim 1 wherein said base iscontoured to fit over a section of the body.
 10. The surgical retractorof claim 9 wherein the section of the body comprises and neck andclavicle section.
 11. The surgical retractor of claim 1 wherein saidbase comprises an integral unit.
 12. A surgical retractor comprising: abase defining an open area therein to be disposed over a surgicalincision in a body, said base having an inner wall facing the open areaand an outer wall facing away from the open area; said base having aplurality of channels therein extending between the inner and outersidewalls, at least one of the channels being at an angle offset fromnormal to the inner sidewall where the at least one channel intersectsthe inner sidewall, and at least one other of the plurality of channelsbeing substantially normal to the inner sidewall where the at least oneother channel intersects the inner sidewall. a respective retractor armcarried within each of the channels for retracting the body to open thesurgical incision, each retractor arm comprising: an elongate sectionslidably carried within a respective channel; and a body engagementextension carried by said elongate section within the open area forengaging the surgical incision.
 13. The surgical retractor of claim 12wherein the open area has a single axis of symmetry.
 14. The surgicalretractor of claim 12 wherein the open area has at least one lobeportion.
 15. The surgical retractor of claim 12 wherein at least one ofthe inner walls and outer walls defines a polygon.
 16. The surgicalretractor of claim 12 wherein said base is contoured to fit over a neckand clavicle section of the body.
 17. A surgical method comprising:positioning a base defining an open area therein so that the open areacorresponds with a surgical incision in a body, the base having an innerwall facing the open area and an outer wall facing away from the openarea; the base also having a plurality of channels therein extendingbetween the inner and outer sidewalls, and at least one of the channelsbeing at an angle offset from normal to the inner sidewall where the atleast one channel intersects the inner sidewall; moving respectiveretractor arms carried within each of the channels to retract the bodyto open the surgical incision.
 18. The method of claim 17 wherein thebase is contoured; and wherein positioning the base comprisespositioning the base over a neck and clavicle section of the body forperforming a thyroidectomy.
 19. The method of claim 17 wherein the atleast one channel comprises a plurality thereof.
 20. The method of claim17 wherein at least one other of the plurality of channels issubstantially normal to the inner sidewall where the at least one otherchannel intersects the inner sidewall.
 21. The method of claim 17wherein each of the retractor arms comprises: an elongate sectionslidably carried within a respective channel; and a body engagementextension carried by the elongate section within the open area forengaging the surgical incision.
 22. The method of claim 21 wherein eachof the retractor arms further comprises a safety stop carried by theelongate section for engaging the inner wall of the base to preventretraction of the incision beyond a safety limit.